Effects of Microdesmis keayana roots on sexual behavior of male rats

In the present study, the aphrodisiac properties of Microdesmis keayana J. Léonard root extract and major isolated alkaloids were evaluated by observing the sexual behavior of male rats. Aqueous extract (150mg/kg body weight) and pure alkaloids (3mg/kg body weight) were administered orally by gavage to male rats. Latent times of observation, intromission and ejaculation, mounting behavior, number of intromissions and mating performances were evaluated and compared to those obtained with untreated rats in the presence of receptive and non-receptive females. The results have shown that aqueous extract and alkaloids of M. keayana stimulate sexual parameters in rats' sexual behavior. A short-term toxicity study undertaken to establish the therapeutic index of aqueous extract, showed that a high dose of the extract (2g/kg body weight) caused no mortality or changes in rats' behavior.

[Endoscopic management of postoperative pancreatic collections]

INTRODUCTION

Treatment of pancreatic postoperative collections are usually managed with a multidisciplinary team. Different managements are possible: abstention, external drainage, endoscopic treatment or surgery.

METHODS

We report on a case series of five patients with a postoperative pancreatic collection, endoscopically managed. Patients underwent all a CT scan associated or not with endoscopic ultrasonography.

RESULTS

An endoscopic cystenterosotomy was performed in all the cases, with two double pig tail stents sometimes associated with nasocystic drainage for clearing the cyst lumen and with transpapillary drainage in one case. All the procedures were successful and patients healed in all the cases with the disappearance of the radiological image within a 33 days to three months range with one complication due to superinfection of the drained cyst, endoscopically managed with a nasocystic catheter.

CONCLUSION

Therapeutic endoscopy, with a multidisciplinary approach, is a promising way to manage postoperative pancreatic collections.

Liver injuries in frontal crash situations a coupled numerical - experimental approach

From clinical knowledge, it has been established that hepatic traumas frequently lead to lethal injuries. In frontal or lateral crash situations, these injuries can be induced by pure deceleration effects or blunt trauma due to belt or steering wheel impact. Concerning the liver under frontal decelerations, how could one investigate organ behaviour leading to the injury mechanisms? This work couples experimental organ decelerations measurements (with 19 tests on cadaver trunks) and finite element simulation, provides a first analysis of the liver behaviour within the abdomen. It shows the influence of the liver attachment system that leads to liver trauma and also torsion effects between the two lobes of the liver. Injury mechanisms were evaluated through the four phases of the liver kinematics under frontal impact: (1) postero-anterior translation, (2) compression and sagittal rotation, (3) rotation in the transverse plane and (4) relaxation.

Experience of two trauma-centers with pancreatic injuries requiring immediate surgery

BACKGROUND/AIMS

Pancreatic injury from blunt trauma is infrequent. The aim of the present study was to evaluate a simplified approach of management of pancreatic trauma injuries requiring immediate surgery consisting of either drainage in complex situation or pancreatectomy in the other cases.

METHODOLOGY

From January 1986 to December 2006, 40 pancreatic traumas requiring immediate surgery were performed. Mechanism of trauma, clinical and laboratories findings were noted upon admission, classification of pancreatic injury according to Lucas' classification were considered. Fifteen (100%) drainages were performed for stage I (n=15), 60% splenopancreatectomies and 40% drainage was achieved for stage II (n=18), 3 Pancreaticoduonectomies and 2 exclusion of duodenum with drainage and 2 packing were performed for stage IV (n=7).

RESULTS

There were 30 men and 10 women with mean age of 29+/-13 years (15-65). Thirty-eight patients had multiple trauma. Overall, mortality and global morbidity rate were 17% and 65% respectively, and the rates increased with Lucas' pancreatic trauma stage.

CONCLUSIONS

Distal pancreatectomy is indicated for distal injuries with duct involvement, and complex procedures such as pancreaticoduodenectomy should be performed in hemodynamically stable patients.

[Evaluation of the in vitro activity of two betalactams on the oxidative metabolism of polymorphonuclear neutrophils]

STUDY AIMS

The aim was to evaluate the in vitro effects of amoxicillin and its combination with clavulanic acid, two beta-lactams intravenously injected, on the oxidative metabolism of polymorphonuclear neutrophils. These cells play the major role in the "respiratory burst" as they produce superoxide anion to kill the infectious agent. An activation of this process by the injected antibiotics could enhance the bactericidal action or explain some of adverse effects.

MATERIALS AND METHODS

Two models were used to estimate the O(2)(-) amounts produced in the presence of the antimicrobial agents. In the cellular model, O(2)(-) was generated by neutrophils artificially stimulated or not (separated by a gradient centrifugation through Histopaque 1077). In the acellular model, O(2)(-) was produced by the xanthine-xanthine oxidase system. O(2)(-) was measured by spectrophotometry using the ferricytochrome C reduction.

RESULTS

The O(2)(-) production by polymorphonuclear neutrophils was increased when both antibiotics were added to the reaction mixture. A significant activation of the cell oxidative metabolism was observed with amoxicillin using various stimulating agents, that was higher without stimulation and lower when amoxicillin and clavulanic acid were associated.

CONCLUSION

Amoxicillin could either activate polymorphonuclear neutrophils NADPH-oxidase or cause its activation by a membrane effect, or interfere with the zymosan activation way. It could then be supposed that this antimicrobial agent intensified the bactericidal effects.

[Pregnant woman and road safety: a numerical approach. Application to a restrained third trimester pregnant woman in frontal impact]

OBJECTIVES

The goal of our work is the development of a numerical model of pregnant woman in driving position. We present an application to the study of injury mechanisms during a frontal car crash for a seat belt restrained pregnant woman in driving position.

MATERIALS AND METHODS

We integrated a digital representation of a pregnant uterus, foetus and placenta in a previous existing numerical model of non pregnant Human body in driving position, the Humos model. The realization of a numerical simulation of a frontal car crash enabled us to analyze the part played by the safety belt in the organic traumatisms.

RESULTS

Three phases were highlighted. The first phase consists of a translation forwards of the pregnant uterus during the impact. The second phase is a rotation forwards in the sagittal plan of the pregnant uterus with for axis of rotation the posterior wall of the pubis. The third phase is a vertical adjustment coupled to a translation of the uterus towards the back. This translation leads the uterus to impact the spine.

CONCLUSION

The development of a pregnant numerical model in the field of accidentology allows the analysis of organic traumatisms. That makes it possible to study the role played by the existing safety systems. This model might make it possible to develop safety systems specific to the pregnant woman.

Effects of static high compression on human foot-ankle: biomechanical response and injuries

To reduce road-traffic fatalities, significant improvements have been seen in the protection of vital body parts. Attention is now focused on serious injuries, which cause disability or impairment as lower limb injuries. The numerical models developed to have a better understanding of injury parameters are evaluated from human responses to load. For this objective, mechanical characterisation tests have been performed on nine human foot/ankle specimens. The responses of three foot contact points during various static loads of the tibia were studied. After each test, an autopsy was performed and the associated injuries were noticed. These tests allowed quantification of the tibia compressive force in relation to foot and ankle deformations up to injury level.

Subcutaneous insulin resistance successfully circumvented on long term by peritoneal insulin delivery from an implantable pump in four diabetic patients

Extreme subcutaneous insulin resistance is a rare syndrome characterized by a severe resistance to subcutaneous (S/C) insulin together with persistence of normal or near normal intravenous (IV) insulin sensitivity. Its pathophysiology is unknown, although increased insulin degrading activity has been reported in the S/C adipose tissue fraction in some cases. Until now, proposed treatments have been disappointing. We report 4 cases who were successfully treated by intraperitoneal (IP) route.

METHODS

The diagnosis of subcutaneous insulin resistance was based upon following combined conditions: resistance to hypoglycaemic action of subcutaneous insulin but normal or near normal sensitivity to IV or IP insulin.

RESULTS

4 patients among those followed by EVADIAC group met these criteria: 3 with type 1 diabetes (C peptide=0), the last one with unexplained non insulin-deficient diabetes (no anti-GAD antibodies, C peptide=5 ng/ml). All of them had been treated with subcutaneous insulin therapy without success despite huge doses (up to 4000 IU/day in two patients). The 3 type 1 diabetic patients presented with a history of repeated ketoacidosis episodes. A treatment of insulin mixed with aprotinin had been proposed to 2 patients without success. The IV insulin sensitivity was proved to be normal in two patients by euglycaemic clamp data. A skin biopsy was performed in 1 patient. An accumulation of insulin in the derma was revealed with no increase of degradation products of insulin. In these 4 patients, a dramatic improvement of diabetes control was obtained by IP insulin delivery from an implantable pump (HbA1c decrease by at least 3%).

CONCLUSION

Although pathophysiology of the subcutaneous insulin resistance syndrome remains unexplained, our data show that intra-peritoneal insulin therapy from an implantable pump allows diabetes control in patients affected by this uncommon but severely disabling condition.

Pedestrian lower limb injury criteria evaluation: a finite element approach

OBJECTIVE

In pedestrian traumas, lower limb injuries occur under lateral shearing and bending at the knee joint level. One way to improve injury mechanisms description and consequently knee joint safety is to evaluate the ultimate shearing and bending levels at which ligaments start being injured.

METHODS

As such data cannot easily and accurately be recorded clinically or during experiments, we show in this article how numerical simulation can be used to estimate such thresholds. This work was performed with the Lower Limb Model for Safety (LLMS) in pure lateral bending and shearing conditions, with an extended range of impact velocities.

RESULTS

One result concerns the ultimate knee lateral bending angle and shearing displacement measurements for potential failure of ligaments (posterior cruciate, medial collateral, anterior cruciates and tibial collateral). They were evaluated to be close to 16 degrees and 15 mm, respectively.

CONCLUSION

The lower leg model used in this study is an advanced FE model of the lower limb, validated under various situations. Its accurate anatomical description allows a wide range of applications. According to the validity domain of the model, it offered a valuable tool for the numerical evaluation of potential injuries and the definition of injury risk criterion for knee joint.

Evaluation of the direct toxicity of trioctyltrimellitate (TOTM), di(2-ethylhexyl) phthalate (DEHP) and their hydrolysis products on isolated rat hepatocytes

Plasticizers are added to polyvinyl chloride (PVC) to confer flexibility to the polymer. Di(2-ethylhexyl) phthalate (DEHP) is the most commonly used of them. However, due to its non covalent bond to the PVC, DEHP tends to vaporize easily. A significant exposure has been recorded in dialyzed patients since medical tubings. Most animal species metabolize DEHP rapidly into monoethylhexyl phthalate (MEHP) and 2-ethylhexanol (2-EH). Because of the suspected toxicity of DEHP, an alternative plasticizer, trioctyltrimellitate (TOTM) has aroused increasing interest. The aim of this study was to determine on isolated rat hepatocytes in vitro, the direct hepatotoxic potential of both DEHP and TOTM and their hydrolytic products. To evaluate the possible toxic liver risk resulting from exposure to DEHP and TOTM, isolated rat hepatocytes were incubated with either DEHP, TOTM, MEHP or their common metabolite (2-EH) for 3 hours. Cell viability was periodically estimated thanks to trypan blue tests (15 - 180 min). The activity of lactate dehydrogenase (LDH) was also monitored (1h, 2h, 3h). The results obtained with trypan blue test and with direct LDH activity measurements, were satisfactorily correlated. Hepatocytes treated with both plasticizers and metabolites on the one hand, and the controls (untreated suspension) on the other hand, showed important differences as for cell viability. The acute toxicity on hepatocytes is mainly due to MEHP. Among DEHP, TOTM, MEHP, 2-EH and after intraperitoneal injection of those compounds, only DEHP and MEHP were able to induce a significant hydrogen peroxide (H2O2) production by the rat hepatocytes. These observations enable us to confirm the hypothesis according to which DEHP and MEHP cause an imbalance between the synthesis and the degradation of H2O2. Our results suggest a short-term in vitro cytotoxicity of MEHP. Even if trypan blue and LDH tests offered good results and were easily branded, further assays as well as MTT-tests should performed in order to confirm the cytotoxicity of the compounds tested.

Compatibility of nitroglycerin, diazepam and chlorpromazine with a new multilayer material for infusion containers

The stability and compatibility of three drugs: nitroglycerin, diazepam and chlorpromazine, with a new multilayer infusion bag were studied. The study was carried out comparatively with PVC bags with which these drugs are incompatible. The drugs were diluted in 5% dextrose or in 0.9% sodium chloride isotonic solutions. Solutions were stored during 8 or 48 h with or without any protection against light. Remaining concentrations of drug were determined by high-performance liquid chromatography (HPLC) during the storage. The admixtures were also monitored for precipitation, color change and pH. Whatever the isotonic solution used, the loss of drugs is in discredit of the use of PVC bags for their storage. So, these three drugs would not be stored in PVC bags. In multilayer bags, no loss of drugs and no color change were detected throughout the storage period. pH values were stable during the same storage period. These three drugs were compatible with multilayer bags in all tested conditions for 8 or 48 h. The leaching of the plasticizer di-(2-ethylhexyl) phthalate (DEHP), that is incorporated into PVC to make the bags soft and pliable was not detected in the three drug solutions during storage period. Our study confirms that these three drugs are incompatible with PVC bags, on the contrary the new materiel tested was proved to be interesting for drug storage.

Are Laparoscopic Staplers Effective for Ligation of Large Intraabdominal Arteries?

OBJECTIVES

To evaluate ligation of aortoiliac arteries with laparoscopic staplers in order to develop specifically designed staplers.

METHODS

Cadaveric study. Seven human cadaver aortas were stapled using EndoGIA60 staplers. Efficiency was evaluated macroscopically and on a hydrodynamic bench. Clinical study. Twelve patients had ligation of 14 large abdominal arteries (aorta: nine, iliac artery: four, hepatic artery: one) using a laparoscopic stapler. Stapling efficiency was judged on peroperative clinical and postoperative CT scan criteria.

RESULTS

Cadaveric study. Stapling was performed perfectly on four moderately calcified aortas, without leakage with a pulsatile pressure of >250 mmHg. For three aortas with severe calcification, stapling was not efficient and major leakage occurred. Clinical study. Stapling appeared clinically efficient on all arteries but one aorta: this severely calcified aorta was ligated conventionally. The staplers are not easy to use due to their shape and their lack of articulation. After a mean follow-up of 31.3 months, all the other stapled arteries were effectively ligated.

CONCLUSION

The commercially available staplers can be used securely on moderately calcified arteries but stapling of severely calcified arteries should be avoided. These devices should be redesigned to facilitate their use in vascular surgery.

Using a finite element model to evaluate human injuries application to the HUMOS model in whiplash situation

STUDY DESIGN

In the field of numerical simulation, the finite element method provides a virtual tool to study human tolerance and postulate on potential trauma under crash situations, particularly in case of whiplash trauma.

OBJECTIVES

To show how medical and biomechanical interpretations of numerical simulation can be used to postulate on human injuries during crash situations. This methodology was applied to whiplash trauma analysis. A detailed analysis of kinematics of joints, stress level in hard tissues, and strain level in soft tissues was used to postulate on chronology and patterns of injury. Data were compared with published biomechanical and clinical studies of whiplash.

SUMMARY OF BACKGROUND DATA

Although many in vitro and in vivo studies have been conducted to investigate whiplash cervical injury, and despite the number of finite element models developed to simulate the biomechanical behavior of the cervical spine, to date, there are only limited finite element models reported in the literature on the biomechanical response of the whole cervical spine in these respects.

METHODS

A complete finite element model of the human body (HUMOS) build in a sitting position in a car environment was created to investigate injury mechanisms and to provide data for automotive safety improvements. It includes approximately 50,000 elements, including descriptions of all bones, ligaments, tendons, skin, muscles, and internal organs. A 15-g whiplash injury was simulated with the HUMOS model. The model predicted cervical motion segment kinematics, deformations of disks and ligaments, and stresses in bone. Model output was then compared with experimental and clinical whiplash literature.

RESULTS

In term of kinematics during the chronology of whiplash, two injury phases were identified: the first was hyperextension of the lower cervical spine (C6-C7 and C5-C6) and mild flexion of the upper cervical spine(C0-C4). The amount of upper cervical flexion was 15 degrees from C0 to C4. The second phase was hyperextension of the entire cervical spine. Potential patterns of ligamentous injuries were observed; the anterior longitudinal ligament experienced the most strain (30%) at the lower cervical spine at the time of lower cervical extension and the interspinous ligament experienced the most strain (60%) at the time of upper cervical flexion. Von Mises stresses in bone do not exceed 15 Mpa, which is largely under injury levels reported in the literature. CONCLUSIONS.: This study reports a methodology to describe and postulate on human injuries based on finite element model analysis. The output of the HUMOS model in the context of whiplash shows a strong correlation with clinical and experimental reported data. HUMOS shows promise for the modeling of other types of trauma as well.

Coloproctectomie totale avec anastomose iléoanale en deux temps vidéoassistée. Expérience initiale de 12 cas

AIM OF THE STUDY

This study reports our early experience in two-stage video assisted restorative proctocolectomy (RPC).

PATIENTS AND METHODS

From May 1999 to May 2003, 12 video assisted RPCs were performed (mucosal ulcerative colitis: n = 11; familial adenomatous polyposis: n = 1). These patients were matched for age, gender, body mass index and indication for surgery, with 12 patients who underwent RPC by laparotomy (open group).

RESULTS

Median operative time was significantly longer in the video assisted RPC group (400 min; range: 360-490) vs open group (300 min; range: 210-390) (P = 0.003). A conversion in midline laparotomy (under the umbilicus) was necessary in 3/12 patients (25%) in the video assisted RPC group. Return to bowel function and oral intake occurred two days earlier after video assisted RPC (respectively, P = 0.009 and P = 0.0001) but length of stay was not significantly shorter in this group. A complication occurred in 3/12 patients (25%) in both groups, which lead to a reoperation in one patient in the open group (ns).

CONCLUSION

Two-stage videoassisted RPC is feasible at the cost of a lengthening of operative time, Nevertheless postoperative results after video assisted RPC are comparable to those obtained after RPC by laparotomy.

Quality of Life in Patients Treated with First-Line Antiretroviral Therapy Containing Nevirapine And/Or Efavirenz

Objective

To assess whether differences in safety profiles between nevirapine (NVP) and efavirenz (EFV), as observed in the 2NN study, translated into differences in ‘health related quality of life’ (HRQoL).

Design

A sub-study of the 2NN study, with antiretro-viral-naive patients randomly allocated to NVP (once or twice daily), EFV or NVP+EFV, in addition to stavudine and lamivudine.

Methods

Comparing differences in changes of HRQoL over 48 weeks as measured with the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire, using analysis of variance.

Results

The 2NN study enrolled 1216 patients. No validated questionnaires were available for 244 patients, and 55 patients had no HRQoL data at all, leaving 917 patients eligible for this sub-study. A total of 471 (51%) had HRQoL measurements both at baseline and week 48. The majority (69%) of patients without HRQoL measurements did, however, complete the study. The change in the physical health score (PHS) was 3.9 for NVP, 3.4 for EFV and 2.4 for NVP+EFV ( P=0.712). For the mental health score (MHS) these values were 6.1, 7.0 and 3.9, respectively ( P=0.098). A baseline plasma HIV-1 RNA concentration (pVL) ≥100 000 copies/ml and a decline in pVL (per log10) were independently associated with an increase of PHS. An increase of MHS was only associated with pVL decline. Patients experiencing an adverse event during follow-up had a comparable change in PHS but a significantly smaller change in MHS, compared with those without an adverse event.

Conclusions

First-line ART containing NVP and/or EFV leads to an improvement in HRQoL. The gain in HRQoL was similar for NVP and EFV, but slightly lower for the combination of these drugs.